Ancestral Alchemy Academy

School and Youth-Service Provider Registration Form

Name (First, Last)

Email Address

Phone

Organization/Group Name (if applicable)

Number of Youth

Please provide the age range of the youth participant(s): (check all that apply)

0 to 3 years (infants & toddlers)

3 to 6 years (early childhood)

6 to 9 years (early elementary)

9 to 12 (upper elementary)

12 to 15 (middle/high school)

15 to 18 (high school/ intern)

exact ages still to be confirmed; will update during clarity call)

confirm your booking with a

ONE-session payment

This session reserves one session with Ancestral Alchemy Academy. Upon receipt of your one-session payment, you will receive follow-up communication with official registration, onboarding details, and next steps.

choose your preferred payment method

Please select your preferred payment option, submit your payment, and return here to complete your booking.

select your payment platform option:

PayPal @ancestralalchemist

Venmo @ancestralalchemyacademy

Zelle lamadretiarra@gmail.com

I hereby certify that all information provided above is true and correct and that I have submitted payment using one of the approved payment methods listed